Medicare Secondary Payer Recovery Portal (MSPRP)
High Level Overview
Conference dial in (888) 790 – 1953conference passcode: 7021968
MSPRPBenefits
How to get started using the application
Basic MSPRP functions
Resources to assist you
MSPRP BenefitsWeb-based application to assist you in managing Medicare recovery cases- View case information (including claim line level detail)
- View current conditional payment amount
- Request a copy of the Conditional Payment Letter
- View and dispute claims (pre-demand)
- Initiate the demand process
- View claims and submit redetermination requests (post-demand)
MSPRP Benefits (2)Case management in real time
Electronically submit documentation
New (as of July 2018)- View incoming/outgoing correspondence status
- Request an electronic Conditional Payment Letter
Getting Started
Account Representative
Account ManagerCompletes Account Setup
Manages the company’s account on the MSPRP
Gatekeeper of the MSPRP account- Grant and revoke access to other users (Account
Designees)
Account DesigneesGranted access to MSPRP account by the Account Manager
Once invited, will receive an email with next steps- Create their own MSPRP Login ID and password
View/manage recovery cases
Multi-Factor Authentication (MFA)
Multi-Factor Authentication: Account List
Multi-Factor Authentication: Without MFA
• Without MFA– Masked Claims Control ID
– Limited claims detail
• Total Charges, Reimbursed Amount, Conditional Payment, and Dispute Submitted and Decision Dates
– Masked HICN (when displayed in the Medicare ID field) • First 5 positions of the HICN hidden from view
Multi-Factor Authentication: With MFA
• With MFA– Unmasked Claims Control ID
– Complete claims detail
• Type of Service, Processing Contractor, Provider Name, Diagnosis Codes, DRG Cd, CPT/HCPSCs, From Date and To Date
– Unmasked HICN (when displayed in the Medicare ID field)
Multi-Factor Authentication: Login with MFA
Case Access
Case Access: Account List
Case Access: Case Listing
Case Access: Search
Beneficiary Debtor Case
CMS is pursuing recovery from the beneficiaryCase ID begins with a 2BCRC sends correspondence- Beneficiary is the primary recipient
- Authorized parties receive carbon copies
Beneficiary and those authorized by the beneficiary can take action on the case
Insurer Debtor Case
CMS is pursuing recovery from an insurer
Case ID begins with a 3*
CRC* sends correspondence
– Insurer is the primary recipient
– Beneficiary and any authorized parties receive carbon copies
Insurer and those authorized by the insurer can take action on the case
*In limited instances, BCRC may send correspondence and the case ID will begin with a 2
Case Information
View Case Information
View case status
View recovery correspondence information
View current conditional payment amount
Case Information: Details
Case Information: Payment Information
Case Information: Payment Information (2)
Case Information: Refund Information
Case Information: Letter Activity
Case Information: Letter Activity (2)
Case Information: Letter Activity (3)
Case Actions
Case Information: Actions
Available MSPRP Case Actions
Request a mailed copy of the Conditional Payment Letter- Includes the Conditional Payment Amount and Payment
Summary Form
New for insurers (as of July 2018)Request an electronic copy of the Conditional Payment Letter
Case Actions: Request eCPL
Case Actions: eCPL Confirmation
Available MSPRP Case ActionsView/Dispute Claims
View/dispute claims included in the Conditional Payment amount (Pre-demand)
View/Dispute Claims: Claims Listing
Claims Dispute Verification
Claims Dispute Confirmation
View/Dispute Claims Listing (Pre-Demand)If CMS agrees that the claims are not related to the case:
- Claims will be removed from the Claims Listing page and the conditional payment amount will be adjusted accordingly
- Letter is sent with an updated Payment Summary Form
View/Dispute Claims: Dispute Decision Date
View/Dispute Claims Listing: Available MSPRP Case Actions
Initiate the demand process- Initiate a demand letter earlier than the 30-day time period- Demand letter is mailed within 7-12 business days of request
View/Dispute Claims Listing: Available MSPRP Case Actions (2)
View Claims Listing (Post-Demand)
- You cannot dispute claims on a demanded case, but you can view the claims that are associated to the case
Demand Claims Listing
Redeterminations:Available MSPRP Case Actions
Submit Redetermination Request (Post-Demand)- You have the right to appeal the amount or existence of the
debt or initial determination (demand letter)- To submit a redetermination request (first level appeal),
select the View/Submit Redetermination (First Level Appeal) option on the MSPRP Case Information page
Redetermination Submission
Redeterminations:Available MSPRP Case Actions (2)
View Redetermination Request
- View details of the request: received date, decision and decision date
Redeterminations: Case Information
View Redetermination Submission
Resources to Assist you with MSPRPCurriculum of training materials to assist you, go to: - http://go.cms.gov/msprp
MSPRP User Guide- Available under the ‘Reference Material’ menu option of the MSPRP
Application (https://www.cob.cms.hhs.gov/MSPRP)
For assistance with MSPRP registration or technical issues, contact the EDI Department- 1-646-458-6740
Resources to Assist you with MSPRP (2)
Additional information and training on Coordination of Benefits & Recovery, go to: http://go.cms.gov/cobro
For details about beneficiary and insurer recovery, go to: http://go.cms.gov/NGHPR
Future EnhancementsReport a liability, auto/no-fault, or workers’ compensation case on the MSPRP
Submit payments for recovery cases on the MSPRP
Check the COB&R Overview What’s New page for announcements: http://go.cms.gov/cobro